Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures |
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Authors: | Margaret Gourlay Nora Franceschini Yevgeniy Sheyn |
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Institution: | (1) Department of Family Medicine, University of North Carolina, Chapel Hill, Manning Drive, CB # 7595, Chapel Hill, NC 27599-7595, USA;(2) Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA;(3) Division of Rheumatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA |
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Abstract: | Glucocorticoids are the most common cause of drug-related osteoporosis. We reviewed current evidence on risk factors for glucocorticoid-induced
osteoporosis (GIOP) and prevention and treatment of GIOP-related fractures. Guidelines for GIOP management published since
2000 were also reviewed. Significant bone loss and increased fracture risk is seen with daily prednisone doses as low as 5 mg.
Alternate-day glucocorticoid therapy can lead to similar bone loss. No conclusive evidence exists for a safe minimum dose
or duration of glucocorticoid exposure. Physicians should consider risk factors for involutional osteoporosis such as older
age, postmenopausal status, and baseline bone density measurements as they assess patients for prevention or treatment of
GIOP. Bisphosphonates were reported to reduce GIOP-related vertebral fractures, but inconclusive data exist for hip fractures
associated with glucocorticoid use. Hormone replacement therapy and parathyroid hormone analogs are effective in preserving
bone density in GIOP. The risk of osteoporosis and fractures should be routinely assessed in patients receiving glucocorticoid
therapy. Effective prevention and treatment options are available and can result in meaningful reduction of GIOP-related morbidity
and mortality. Current guidelines for GIOP management recommend bisphosphonates, especially alendronate and risedronate, as
first-line agents for GIOP, and these guidelines propose the preventive use of bisphosphonates early in the course of glucocorticoid
therapy in high-risk patient subgroups. |
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Keywords: | Fracture Glucocorticoid Osteoporosis Prevention Treatment |
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